Marlot Kuiper

173 Checklist as ‘hub’: On routine interactions 6.3.1 Ticking time and the irony of planning Trauma surgeons deal with injuries that are caused by an impact. Trauma can be caused by falls, car accidents, or cyclist struck by a car. Trauma patients can also be the victims of stabbings or gunshot wounds. Trauma surgeons therefore must be familiar with a wide variety of general, thoracic, and vascular procedures, and they must be able to make complex decisions, often in an acute setting with little time and insufficient information. Some of the conditions caused by a trauma are harmful and painful, but not immediately life threatening. An operation to stabilize a severely broken limb for example, can be scheduled. Other conditions, for example internal bleedings, require immediate action, these are ‘Level A’ emergencies. For trauma surgery, emergency is ‘standard’. Emergency is expected. Nonetheless, it complicates the performance of the checklist routine as the flux of routines is never established and static. A day at the trauma department can be considered a ‘critical case’, illustrating the irony of planning, and the consequences for safety checklist performances. It is 6.30am when I park my car at the huge parking garage next to Plainboro’s hospital. It is early February, and it is cold and still dark outside. It strikes me how many cars are already parked at this hour. About fifteen minutes later I meet dr. Doornwaard, the trauma surgeon, while he is already running through the OR program of the day. The day starts at 7.00am with a round over the wards visiting the patients who are planned for surgery today or patients that need extra care. We have to hurry to make it to the patient handover in the trauma surgery department at 7.45am, where the status of the patients is discussed with all the trauma surgeons. The handover has already begun, and several clinicians are still walking in and out. We have been at the handover for only five minutes when dr. Doornwaard nods at me to leave. We have to go to the surgery department for the morning briefing. In the briefing, four scheduled operations are discussed. After two of these operations, dr. Doornwaard has to operate a girl from the ‘emergency list’, so the program has to be rescheduled. At noon, we are ready to continue 6